How Many Timed Units Can I Bill In An Hour?
A question I am often asked is how many 15-minute time-based units can I bill in an hour? Or phrased another way, I can only bill 4 15-minute time-based units in an hour, correct? The simple answer is that it’s possible to bill more than 4 15-minute time-based units in an hour, even if you had an all Medicare outpatient therapy population. In this article, I will provide examples of how it’s possible to bill more than 4 15-minute time-based units in an hour for both Medicare patients and commercial insurance patients just using one therapist or one therapist/therapy assistant and not using any support personnel.
Let’s begin!
Question
Can you bill 5 15-minute time-based units in an hour with Medicare patients?
Answer
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Question
Can you bill 6 15-time-based units in an hour?
Answer
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Question
Is it possible to bill 7 15-minute time-based units in an hour?
Answer
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Question
Is it possible to bill more than 32 15-minute time-based units in an 8-hour workday?
Answer
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I hope you found this article helpful in showing you how it’s possible to legally bill more than 4 15-minute time-based units in an hour. Thank you for being a Gold Member!
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
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Our company has a gold membership. Is there any way I can get logged on without knowing what the other person put in for a password?
No
We had claims deny due to more than 6 units of 97530 for one pt on one day. However, the units are split between PT and OT with appropriate modifiers (-GP & -GO) on the claim. Is there a step we are missing?
The simple answer is an insurance carrier could limit the number of units of a specific CPT code reimbursed on the same day by either the same discipline or the same practice or organization. Who was the insurance carrier?
The carrier is Medicare
Stay tuned for my article that I will publish next Monday.
Do you have a list of what insurances follow AMA billing guidelines?
No, since there are so many insurance carriers. You will need to read the applicable therapy policies of the insurance carrier plus your contract.